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Special Article
Oct 2011

Evidence and the Effective Clinical Neurologist: The 2009 H. Houston Merritt Lecture

Arch Neurol. 2011;68(10):1252-1256. doi:10.1001/archneurol.2011.237

For generations, neurologists have been trained to test their clinical hypotheses by obtaining detailed histories and performing neurological examinations to arrive at a complete differential diagnosis. Additional investigations and imaging narrow the diagnoses to those pertinent to the patient. Choice of therapy considers the benefits and risks of each potential treatment for that complex individual. It is necessary to have substantial knowledge about the patient and his or her social milieu and psychological makeup. This approach can be characterized as “personalized medicine” because it emphasizes the medical and personal details of each individual. This system was taught by Dr H. Houston Merritt (Figure 1), for whom this lecture is named, and by myself and my mentors in neurology; furthermore, it is the backbone of a monograph by me and Joshua Hollander titled The Effective Clinical Neurologist, now in its third edition.1